Leah Millheiser, MD
Leah Millheiser, MD, is a clinical assistant professor in the department of obstetrics and gynecology and director of the Female Sexual Medicine Program at Stanford University School of Medicine in Stanford, California.
Ever since an FDA advisory panel rejected the approval of a so-called “female Viagra” last year — the drug was deemed no more effective at increasing libido than a placebo — there’s been a lot of a debate on the female libido. Key issue: If a woman’s desire for sex is low, is that necessarily a “dysfunction” that should be treated? What women — and their partners — need to know…
When it comes to libido, medical experts agree that there is no “normal” or “abnormal.” Doctors diagnose a libido dysfunction only when there is a recurrent or persistent problem with libido that causes personal distress to the woman.
Therefore, if a woman has no sexual desire but is undisturbed by this fact, then no dysfunction exists. Alternatively, if a woman wants to have sex twice a week but is distressed because she used to want it more often than that, then the decrease in libido is a dysfunction for her.
To diagnose low libido: A woman needs to answer just one basic question — do you think you have a problem with your level of sexual desire? Note: When a man and woman’s desire don’t match, it’s called “desire mismatch,” which is not truly a sexual dysfunction, though the partners may benefit from sex therapy.
Not all doctors ask about their patients’ sexual health, so any woman who experiences chronic or recurrent low libido should tell her gynecologist and/or primary care physician. Most common causes…
Health problems. Some chronic diseases, such as diabetes and atherosclerosis (clogged arteries), can decrease blood flow — including that feeding the sex organs. Without proper blood flow, sex can feel uncomfortable, and orgasm may be impossible — both of which may negatively impact a woman’s libido. And because sexual desire starts in the brain, doctors shouldn’t ignore the possibility that low desire could be a side effect of a brain injury from, say, a fall, car wreck or stroke.
Medication use. The side effects of many drugs may include a change in sexual desire and/or difficulty reaching orgasm. Common culprits: Antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft)… and cholesterol-lowering statin medications, such as atorvastatin (Lipitor) and simvastatin (Zocor).
Psychosocial factors. If a woman is in a relationship that is physically, emotionally or verbally abusive, her sexual desire can diminish. Past physical or sexual abuse can also lower libido. Any woman experiencing abuse should work with her doctor to create a plan to improve the relationship or leave it. Those experiencing current or past abuse may also benefit from therapy.
Partner’s health issues. If a woman with low libido has a partner who has a sexual dysfunction — such as low sex drive, erectile dysfunction or inability to orgasm — both partners can drag each other’s desire down even further. Therefore, both people should be evaluated by a sex therapist.*
Hormone levels. The primary male hormone (testosterone), which is also present in females, plays a crucial role in women’s libido. Postmenopausal women, in particular, have decreased testosterone, which lowers libido and makes it more difficult to have an orgasm. Premenopausal women may experience lowered testosterone levels if they take birth control pills.
While it might seem that taking testosterone would be an easy fix for libido, research has been mixed. Some studies have shown a benefit, while others have shown no or only slight improvement in sexual desire. Because the potential side effects (such as excessive body hair and acne) are serious, women taking testosterone need to be carefully monitored with blood tests every three to six months.
It’s important to work with your doctor to rule out underlying physical problems that may be leading to your low libido. In the meantime, simple therapies may help…
*To find a sex therapist or MD in your area who specializes in treating sexual dysfunction, consult the International Society for the Study of Women’s Sexual Health, www.isswsh.org.
**All the products mentioned in this section can be purchased from www.Drugstore.com, which ships its orders in a plain box labeled only with the company name.